Healthcare Provider Details

I. General information

NPI: 1700921376
Provider Name (Legal Business Name): MARTHA DANIEL CHAPMAN PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 BERGQUIST DR LACKLAND AIR FORCE BASE
LACKLAND A F B TX
78236-9907
US

IV. Provider business mailing address

2200 BERQUIST DR
SAN ANTONIO TX
78255-2035
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-5478
  • Fax: 210-292-5419
Mailing address:
  • Phone: 210-292-5478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202203433
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS31545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: